Self dilation as a treatment for resistant benign esophageal strictures: outcome, technique, and quality of life assessment

Abstract

Background: Resistant benign esophageal strictures can have a negative impact on patients' quality of life. A portion of these patients require frequent physician performed dilations, leading to numerous interactions with their attendant inconvenience and sense of dependence. This study demonstrates the efficacy, safety and effect on quality of life of this under-utilized technique.

Methods: A retrospective chart review was performed for all patients undergoing esophageal self dilation at our institution between January 2003 and November 2009. The impact on quality of life was evaluated using a telephone questionnaire specifically designed to explore emotional, social and financial impacts.

Results: Of the 11 patients who initially began self dilation for non-malignant strictures, nine are included in this study. Median follow-up was 35.4 months (range 6-168). No significant complications were reported. When asked to compare self dilation with physician performed dilation a large proportion of patients reported financial benefits, and a majority reported being more socially active. Overall quality of life improvement was reported by almost all of the participants in the study. Global scores for dysphagia and overall quality of life were significantly improved under conditions of self dilation versus physician performed dilation (P = 0.008 and P = 0.016, respectively).

Conclusions: Our results suggest that esophageal self dilation can be a safe and effective treatment modality in motivated patients with benign resistant esophageal strictures. Esophageal self dilation has a positive impact on emotional, social, and financial aspects of patient's life. Self dilation should be considered a treatment option in all patients with benign resistant esophageal strictures.